DOI: http://dx.doi.org/10.4314/star.v4i4.14 ISSN: 2226-7522 (Print) and 2305 -3372 (Online) Science, Technology and Arts Research Journal Sci. Technol. Arts Res. J., Oct-Dec 201 5, 4(4): 99-105 Journal Homepage: http://www.starjournal.org/

Original Research

Ten Years Trend Analysis of Malaria Prevalence and its Correlation with Climatic Variables in District, East Wollega Zone, Regional state, Western : A Retrospective Study

Temesgen Gemechu 1, Abdi Samuel 2* and Delensaw Yewhalaw 1

1Department of Biology, College of Natural Sciences, Jimma University, PO Box: 378, Jimma, Ethiopia 2Department of Medical Laboratory Sciences, College of Medical and Health Sciences, Wollega University , PO Box: 395, , Ethiopia Abstract Article Information Malaria is one of the most devastating diseases in the World and caused by a protozoan Article History: parasite of the genus Plasmodium. The disease remains one of the most important causes Received : 28-09-2015 of human morbidity and mortality with enormous medical, economic and emotional imp act in the world, and in most African countries including Ethiopia. The complexity of the Revised : 19-12-2015 disease control process, expensiveness of the control program, resistance of the parasite Accepted : 24-12-2015 to anti-malarial drugs and vectors to insecticides are some of the challenges. The aim of

the study was to assess the ten years trend analysis o f malaria prevalence and its Keywords : association with climatic variables in the Sibu Sire district, Western Ethiopia. Ten years P. falciparum (2004-2013) malaria clinical and epidemiological data were collected from health facilities Malaria and climatic variables data from Ethiopian M eteorological agency. The data were analyzed using SPSS software package 16.0. Pearson’s correlation analysis was conducted to see Morbidity and mortality the correlation between plasmodium species and climatic variables. Within the last decade Climatic Variables (2004–2013) a total of 30,070 blood films were examined for malaria in Sire health center and of this 6036 (20.07%) microscopically confirmed malaria cases were reported in the Economic impact health center and P. falciparum becoming a predominant species. The result showed that Epidemiological data maximum temperature, mean temperature and average relative humidity showed significant association with malaria ( P<0.01).But minimum temperature (P=0.094) and *Corresponding Author: rainfall (P=0.729), were not significant. In addition, regression analysis suggested that minimum temperature, rainfall, an d average relative humidity ( P<0.001) were statistically Abdi Samuel significant but the mean temperature (P=0.706) was insignificant. In conclusion the trend of malaria in the study area had a reducing but a fluctuating pattern and some of the E-mail: metrological variables such as minimum temperature, rainfall, and average relative humidity were statistically significant . [email protected] Copyright@201 5 STAR Journal , Wollega University . All Rights Reserved.

INTRODUCTION Malaria is one of the most devastating diseases in the is regarded as malarious (MoH, 2008). P. falciparum and World. There are ninety seven countries and territories P.vivax are the two predominant malaria parasites, with ongoing malaria transmission, and seven countries in distributed all over the country and accounting for 60% the prevention of reintroduction phase, making a total of and 40% of malaria cases, respectively (MoH, 2002). 104 countries and territories in which malaria is presently considered endemic. Globally, an estimated 3.4 billion Malaria transmission in Ethiopia is seasonal and people are at risk of malaria. WHO estimates that 207 unstable, depending mostly on altitude and rainfall million cases of malaria occurred globally in 2012 (WHO, (Deressa et al ., 2003). The two main seasons for 2013). The disease remains one of the most important transmission of malaria in Ethiopia are September to causes of human morbidity and mortality with enormous November, sometimes extended to December after heavy medical, economic and emotional impact in the world summer rains, and March to May, after the light rainy (WHO, 2011), with2-3million deaths occurring each year shower. Malaria epidemics are relatively frequent (Snow et al ., 2005). It is the leading cause of death in involving highland or highland fringe areas, mainly areas children under the age of 5 years and pregnant women in 1,000–2,000 meters above sea level, in which the developing countries (Martens, 2000; Lagerberg, 2008). population lacks immunity to malaria (Endeshaw et al ., 2008) . Meteoro logical factors have been considered as It is estimated that 68% of the population lives in important drivers of malaria transmission by affecting both malarious areas and three quarters of the t otal land mass malaria parasites and vectors directly or indirectly A Peer -reviewed Official International Journal of Wollega University, Ethiopia 99

Temesgen Gemechu et al ., Sci. Technol. Arts Res. J., Oct-Dec 2015, 4(4): 99-105 (Pemola and Jauhari, 2013). Besides this, other factors, Data Processing and Analysis such as any change in land use patterns and construction The data were analyzed using SPSS version 16.0 of water control could have considerable effects on software package. Descriptive statistics was employed to malaria transmission (FMOH, 2007). present overall malaria prevalence, age and sex specific malaria, correlation with climatic variables. Average yearly Changes in temperature, rainfall, and relative humidity mean temperature, total rainfall and relative humidity due to climate change are expected to influence malaria (January through December for each year) were directly by modifying the behavior and geographical calculated. All data from meteorological and clinical distribution of malaria vectors and by changing the length records were checked for completeness and cleaned of of the life cycle of the parasite. Climate change is also any inconsistencies. To observe the correlation between expected to affect malaria indirectly by changing meteorological variables and malaria cases, the monthly ecological relationships that are important to the malaria cases were regarded as the dependent variables, organisms involved in malaria transmission (the vector, while meteorological variables such as monthly maximum, parasite, and host) (Abebe et al ., 2011). Because of those minimum and mean temperature, total monthly rainfall challenges malaria is one of the main public health and monthly relative humidity were independent variables. problems in the study area. Therefore, this study is Pearson’s correlation analysis was conducted to examine initiated to analysis the ten years trend of malaria the type and strength of relationship between prevalence and to determine any patterns of correlation meteorological variables and malaria. Then to observe existing between meteorological factors and malaria over independent effect of each independent variable on the last decade in the study area. outcome, variable linear regression was fitted. Since there might be auto-correlation among independent variables MATERIALS AND METHODS over time, autocorrelation analysis was conducted. Study Area and Period The study was conducted in Sibu Sire district, East Ethical Considerations Wollega Zone of Oromia Regional State, Western Ethical clearance was obtained from Jimma University Ethiopia from 2004-2013. It is one of the districts in east College of Natural Science and written consent was Wollega Zone and is located 281Km in West from Addis sought from the head of Sire district health office to Ababa and 50km East from Nekemte, the administration undertake the study. Individual information was kept town of East Wollega Zone. This district is bordered in the confidential and the names of individuals were removed East by , in the West by WayuTuka, in South from the data taken from health center and identified only by and Billo Boshe and on the North by by identification numbers and the results were and . This district has 22 kebeles communicated in an aggregated manner. from these 19 kebeles are rural and 3 municipals. The study area has a total population of 124,304 and from RESULTS these urban dwellers male6744 and female 6954, rural During the study period (2004–2013) a total of 30,070 dwellers male 54,920 female 55,686.Sibu sire district has blood films were requested for malaria diagnosis in Sire an estimated population density of 27.8 people per square health center and 6036 (20.07%) microscopically kilometer (SSDA, 2013). confirmed malaria cases were reported in the district with mean malaria cases of 603.6. A minimum (1.6%)number Topography and Climate of microscopically confirmed malaria cases being reported The altitude of the district ranges between 1360masl to in 2008 and the maximum (31.2%) microscopically 2500masl.There is three agro-ecological zones confirmed cases of malaria being reported in 2004.The represented in this district. The majority (74.3%) of the prevalence of malaria varies between sex and among district is classified as mid-land with lowland (18.27%) and place of residence, age ,month, season and year. In only 7.53% is considered as highland. The minimum, addition, the types of plasmodium species and the drug maximum and mean temperature of this area was 14.09 used within these years also varied. ºc, 27.30 ºc, and 22.55 ºc, respectively. The highest temperature occurs in February and March. The lowest The result of the study showed that malaria prevalence temperature occurs in July and august. The annual was higher in males than females. From the infected average rainfall of the district is 1295mm (RLEPOSSD, patients (53.6%) were male and (46.4%) were female but 2013). the difference was not statistically significant (p=0.998) According to the data review in the last ten years in the Study Design and Population study area for the Prevalence of malaria parasites in A retrospective study was employed to collect malaria relation to residence area in Sibu Sire district people who epidemiological data from district health services to live in rural areas were more affected by malaria than determine the ten year trend prevalence of malaria by those who live in urban areas. The infection rates among reviewing blood film malaria record from Sire health rural people were (69.3%) and urban people were center and metrological variables were collected from (30.7%). There was no significant difference (p=0.436) National Meteorology Agency. between rural and urban residences.

In the study area peripheral smear examination of Malaria case was reported in all age groups in the Giemsa stained blood film is used as the gold standard in area but the age group between 15-44 years was more confirming the presence of the malaria parasite as per the affected, with a prevalence rate of (48.1%), followed by 5 - WHO protocol. The study participants were all individuals 14 years old and 1-4 years old with the prevalence rate diagnosed for malaria using giemsa stained preparation (28.2%) and (15.4%), respectively. On the other hand, and the data registered on laboratory registration book children below 1years old and above 64 years old were during the study period (2004 -2013). less affected with prevalence rate of 2.3% and 1%,

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Temesgen Gemechu et al ., Sci. Technol. Arts Res. J., Oct-Dec 2015, 4(4): 99-105 respectively. But the difference was statistically not malaria prevalence was reported. When we observe significant (p=0.712). figure 1 the P. falciparum highly decreased from2004 up to 2008 and again rise starting2009 in 2010 remarkably Malaria was reported in all years in the study area but increase and in 2011 become below the prevalence of in 2004, the prevalence rate was high (31.2%), followed P.vivax . In contrast to these in 2011 P. vivax prevalence by 2010, 2005 with the prevalence rate (13.7%) and was elevated a little above P. falciparum in the study area. (13%), respectively. Similarly, the prevalence rate of The prevalence of mixed infection ( P. falciparum and P. malaria in 2012, 2013 and 2009 was (9.8%), (9.7%) and vivax ) remained almost the same from 2004 up to (9.3%), respectively. But the rest years less number of 2013(figure 1).

Figure 1: Trend of malaria prevalence with Plasmodium species and year in Sire health center, 2004 - 2013.

Despite the apparent fluctuation of malaria trends in February and March were low when compared with other the study area; malaria cases occurred in almost every months with prevalence rate of 4.2%, 4.2%, 4% and season of the years. The highest peak of malaria cases in 2.9%respectively. Although a seemingly uniform monthly almost all years was observed during the wet season, with health center record, having higher values were recorded prevalence rate of (68.36%) and the dry season with in Sibu Sire district starting from May up to November. prevalence rate of (31.64%), which was statistically significant (P=0.001). Figure 2 below showed that there was fluctuated trend of P.falciparum and P.vivax throughout the year in Malaria occurred in all months of the year with different different months. The peak malaria cases were seen in fluctuation rate. The highest peak is in June with June, May, and November months with high P.falciparum prevalence rate 18.9%, followed by May, November, and and then P.vivax respectively. In contrast, the less malaria July with prevalence rate 13.3%, 13.2%, and 11.2%, cases were confirmed in March, April, February, respectively. The prevalence rate in October, August, and December, and January months respectively. Almost the September were 9.4%, 8.7%, and 7%, respectively. On mixed cases less fluctuate through each month. other hand, the spread of malaria in December, January,

900 P.f 800 P.v Mixed 700 600 500 400 300

Monthly malaria case malaria Monthly 200 100 0 January Feburary March April May June Julay August September October November December Months Figure 2: Trend of malaria prevalence with Plasmodium species and month in Sire health center, 2004 – 2013

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Temesgen Gemechu et al ., Sci. Technol. Arts Res. J., Oct-Dec 2015, 4(4): 99-105 Regarding the identified plasmodium species, both P. vivax in the study area. species of plasmodium were reported in each year with P. falciparium being the predominant species in the study Of the cases diagnosed for malaria from different area. P. vivax accounted for 66.1% and 30.5% of malaria kebeles the highest (23.7%) malaria confirmed cases cases, respectively and the mixed (both P.falciparum and were from Jarso Wama kebeles, followed by Sire-02 P.vivax ) accounted 3.4%. In the year 2011 P. falciparum kebele(16.9%), Sire-01 kebele(13.9%%), Bikila was decreasing while P. vivax was increasing, which kebele(13.2%) and Lalisa(9.4%). Figure 3 below showed showed that there was a trend shift from P. falciparum to the fluctuating trends of malaria in the study area.

Figure 3: Annual trends in total malaria cases in Sire Health Center, 2004 – 2013

Correlation between Malaria and Meteorological study area from 2004 to 2013 was showed that low Variable temperature (18.67 oc) in 2011 and high temperature The study area is generally characterized by moderate (26.87 oc) in 2004. A high fluctuating trend in temperature climate with a mean annual maximum and minimum was observed during the study period. The condition of temperature 27.3 0c and 14.09 0c. The annual rainfall rain fall in the study area in the past ten years (2004- ranged from 650mm to 2590mm.The annual mean 2013) indicated that minimum rainfall 650mm, maximum relative humidity 68.66% from 2004 to2013 in study area. rain fall 2590mm and mean annual rainfall 490mm. However, a high fluctuating trend of rainfall was recorded In general, the relationship between malaria cases and through the years of 2004 to 2013. meteorological variables were checked by using mean and standard deviation and also further checked by Pearson’s correlation analysis was employed to Pearson’s correlation and linear regression analyses assess the correlation between malaria and climatic (table 1). variables (temperature, rainfall, and relative humidity). It showed that maximum temperature (P=0.007), mean Depending on climate variable in 2004 the mean temperature (P=0.001) and average relative humidity minimum temperature higher than the mean minimum (P=0.001) showed significant correlation with malaria. But temperature in2008 and also average relative humidity of annual mean minimum temperature (P=0.094) and annual 2004was greater than the average relative humidity in rainfall (P=0.729) were not statistically significant. 2008. Moreover, the annual mean temperature of the

Table 1: Mean and Standard deviation of different species of Plasmodium with climate variable

Plasmodium Mean temp. Minimum temp. Maximum temp. Rain fall Relative humidity species Mean(±SD) Mean(±SD) Mean(±SD) Mean(±SD) Mean(±SD) Mixed 19.98±3.82 13.7±3.4 25.38±5.54 7.42±7.28 67.7±15.78 P.F 22.33±3.26 14.08±1.38 27.45±2.88 4.79±3.93 69.39±16.03 P.V 23.35±4.35 14.19±2.33 27.19±3.86 4.84±5.06 67.24±16.59 Total 22.54±3.69 14.09±1.79 27.3±3.34 4.90±4.47 68.66±16.22 P-value 0.001 0.004 0.001 0.001 0.001 Key- SD-Standard deviation

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Temesgen Gemechu et al ., Sci. Technol. Arts Res. J., Oct-Dec 2015, 4(4): 99-105 The malaria cases were positively correlated (+0.028) North Gonder, and North West Ethiopia was obtained the with annual minimum temperature, (+0.128) with annual same result. average mean temperature, and (+0.005) annual total rainfall. The negative correlation of malaria cases were Malaria occurred in almost every season of the year. observed (-0.037) with annual average maximum The highest peak of malaria observed in summer. So the temperature and (-0.062) with annual average relative season before the dry season has rain and temperature humidity. that enough for Sporogonic cycles reproduction of Anopheles mosquitoes. A study by Jason (2007) in DISCUSSION Democratic People’s Republic of Korea has similar results The result of this study revealed that during the last in that the summer season has highest malaria incidence. ten years, a fluctuating trend of occurrence of malaria The district have high irrigation farming in the Autumn cases was observed in SibuSire district almost similar to Season these condition may be increase the number of the study conducted in Kola Diba health center, North malaria transmitting mosquitoes. The same result can be Gonder by (Abebe et al ., 2012) and also the study done in found in China and India Country (Peng et al ., 2003; Butajira by(Tesfaye et al ., 2012). An increase in malaria Pemola, 2006; Srinivasulu, 2013). cases occurrence with peak cases occurring in 2004 was similar with the thesis conducted in Mvomero, by The study also showed that the highest peak of (Xiaochen, 2013), and malaria cases were reduced the malaria infection was occurred in June with high following three consecutive years (2006-2008) but a occurrence of malaria which could be due to the fact that remarkable increase in 2010 was observed. Except for the June is the starting time for Summer season and May the year 2011, the remarkable increment of total malaria last month in autumn season was suitable condition for cases was mainly due to an increase of P.falciparum with malaria disease increment that is the amount of little increase of P.vivax . But for 2011 total malaria cases, temperature and rain enough for the reproduction of P.vivax contributed more than P.falciparum the same to mosquitoes and Plasmodium species (Peng et al ., 2003; the study done by (Abebe et al ., 2012) in Kola Diba health Pemola, 2006). center and also Similarly the study conducted around Gilgel Gibe show that in 2008 and 2010 when the P. P. falciparum was the predominant species followed vivax prevalence was elevated a little above P. falciparum by P. vivax in the study area and the prevalence rate (Sena,2014). Resistance of P.vivax to the commonly accounted for 3991(66.1%) and1842 (30.5%) used drug (chloroquine) during these years may have respectively. The study conducted in Sarbo, Kola Diba, contributed to total malaria case occurrence (WHO, 2003; Butajira health center and Metema Hospital by (Abebe et MoH, 2004; Jima, 2005). al ., 2012; Karunamoorthi and Bekele, 2012; Solomon et al ., 2012; Getachew et al ., 2013) almost similar to these A decrease in malaria cases occurrence after the 2004 results. Other earlier studies have also documented the maximum occurrence was observed. The increased predominance of P. falciparum species in many places of attention to malaria control and preventive activities by Ethiopia. different responsible bodies, increased awareness of the community on use of ITNs and other malaria control The major climatic factors that have an impact on activities, increased accessibility of ITNs to community, malaria transmission due to spatio-temporal changes in increment of budget for malaria control and prevention malaria vectors are temperature, relative humidity (RH) activities might contributed the decrement in malaria case and precipitation (Pampana, 1969). Increasing occurrence in addition to meteorological factors (Abebe et atmospheric temperature causes decrease in the duration al ., 2011; Abebe et al., 2012). of the gonotrophic cycle as well as the extrinsic incubation period, leading to increased biting frequency, and In this study, males were more affected than females. therefore, increased rate of malaria transmission Because they stay outdoors to keep agricultural products (Molineaux, 1988). at night when mosquito becomes active to find food (meal).The results were comparable with an earlier study, Unlike some diseases, which flourish under one carried out by. (Jamaiah et al ., 1998; Karunamoorthi and particular set of environmental conditions, the Bekele, 2009; Abebe et al ., 2012; Getachew et environmental factors that contribute to the transmission al ., 2013).The female population mostly stays back in the of malaria vary greatly from one ecological zone to house, thus their contact with malaria infection is another. Of all of these, the two most important ones are minimized. Malaria prevalence was more series in rural temperature and humidity. Organisms cease to develop in than urban because rural communities they do not use the mosquito when the temperature falls below 16°C. At bed net appropriately. In addition their houses are full of 20°-30°C, the parasites develop optimally in the vector. cracks and holes so mosquito can easily enter it. The High humidity prolongs the life of the vector and number of kebeles in the rural area is 19 and there is only transmission is extended under these conditions. In the 3 urban kebeles in the district. This has contributed to the human host, the parasite must function at 37°C or higher, increment of the number. This study had also showed since the infection induces a significant rise in core similar result to the study done by (Abebe et al ., 2011) in temperature during the height of the infection (Githeko, Jimma town, South-West Ethiopia. 2008; Anon, 2012).

The age group 15-44 years was more affected with Temperature rise is expected to increase transmission malaria. This could be attributed to the fact that people in and prevalence of malaria by reducing the interval this age group stay outside till late evening for work as between mosquito blood meals, thus decreasing the time they are in productive age. This is consistent with a the to produce new generations and by shortening the study conducted by Abebe et al . (2012) in Kola Diba, incubation period of the parasite in the mosquitoes. Sporogonic cycles take about 9 to 10 days at

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Temesgen Gemechu et al ., Sci. Technol. Arts Res. J., Oct-Dec 2015, 4(4): 99-105 temperatures of 28°C but higher than 30°c and below control activities in each year, such as indoor residual 16°C have negative impact on parasite development spraying, environmental management, health education (Craig, 1999). Also the minimum temperature for P. about malaria, distribution of LLINs and anti-malarial falciparum and P.vivax parasite development drugs and other activities to decrease mortality and approximates to 18°C and 15°C, respectively and the morbidity of malaria, the prevalence is still sustained. daily survival of the vector is dependent on temperature as well. At temperatures between 16°C and 36°C, the CONCLUSIONS daily survival is about 90%. The highest proportion of The study showed a decrease but fluctuating trend in vectors surviving the incubation period is observed at the last ten years (2004 – 2013). When compared with the temperatures between 28° - 32°C. So, temperature of previous prevalence of malaria currently there is a big 20°C to 30°C and relative humidity greater than 60% are difference that means malaria prevalence is highly optimal for Anopheles survive long enough to acquire and reducing. Metrological variables such as maximum transmit the parasite (Craig, 1999). temperature mean temperature and average relative humidity showed significant correlation with malaria Rainfall plays an important role in malaria transmission. But malaria is still a major public health epidemiology because water not only provides the problem and deadly that needs sustainable intervention medium for the aquatic stages of the mosquito’s life but on variables such as keeping the ecology. also increases the relative humidity and thereby the longevity of the adult mosquitoes (McMichael and Conflict of Interest Martens, 1995). The impact of rainfall on the transmission Conflict of Interest none declared. of malaria is very complicated, varying with the . circumstances of a particular geographic region and depending on the local habits of mosquitoes. Rains may REFERENCES prove beneficial to mosquito breeding if it is moderate, but Abebe, A., Dagnachew, M., Mikrie, M., Meaza, A., Melkamu, may destroy breeding sites and flush out the mosquito G. (2012).Ten year trend analysis of malaria prevalence larvae when it is excessive (McMichael and Martens, in Kola Diba, North Gondar, Northwest Ethiopia. Parasites 1995). & Vectors 5:173. Abebe, A., Gemeda A., Wondewossen T., Lemu G. (2011). The annual total rainfall was positively correlated that Climatic variables and Malaria transmission dynamics in determines malaria transmission in the study area next to Jimma town, South West Ethiopia. Journal of Parasites mean temperature and minimum temperature. 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